Juan Gálvez-Acebal1, Manuel Almendro-Delia2, Josefa Ruiz3, Arístides de Alarcón4, Francisco J Martínez-Marcos5, José M Reguera6, Radka Ivanova-Georgieva3, Mariam Noureddine7, Antonio Plata6, José M Lomas5, Javier de la Torre-Lima7, Carmen Hidalgo-Tenorio8, Rafael Luque4, Jesús Rodríguez-Baño9. 1. Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain. Electronic address: jga@us.es. 2. Cardiology Service, University Hospital Virgen Macarena, Seville, Spain. 3. Infectious Diseases and Microbiology Unit, University Hospital Virgen de la Victoria, Málaga, Spain. 4. Infectious Diseases, Microbiology and Preventive Medicine Unit, University Hospital Virgen del Rocío, Seville, Spain. 5. Infectious Diseases Unit, Juan Ramón Jiménez Hospital, Huelva, Spain. 6. Infectious Diseases Unit, Regional Hospital Carlos Haya, Málaga, Spain. 7. Infectious Diseases Unit-Internal Medicine, Costal del Sol Hospital, Marbella, Spain. 8. Infectious Diseases Unit, University Hospital Virgen de las Nieves, Granada, Spain. 9. Infectious Diseases and Clinical Microbiology Unit, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla, Seville, Spain.
Abstract
OBJECTIVE: To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE). PATIENTS AND METHODS: A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality. RESULTS: A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%). CONCLUSION: This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
OBJECTIVE: To analyze the influence of early valve operation on mortality in patients with left-sided infective endocarditis (IE). PATIENTS AND METHODS: A multicenter cohort study was carried out between 1990 and 2010. Data from consecutive patients with definite IE and possible left-sided IE were collected. Propensity score matching and adjustment for survivor bias were used to control for confounders. The primary outcome was in-hospital mortality. RESULTS: A total of 1019 patients with a mean age of 61 years (interquartile range, 47-71 years) were included. Early surgical treatment was performed in 417 episodes (40.9%). By propensity score, we matched 316 episodes: 158 who underwent early surgical treatment and 158 who did not (medical treatment group). In-hospital mortality and late mortality were lower in the surgically treated group (26.6% vs 41.8%; absolute risk reduction [ARR], -15.2%; P=.004 and 29.7% vs 46.2%; ARR, -16.5%; P=.002, respectively). Operation was independently associated with a lower risk of in-hospital mortality (odds ratio, 0.42; 95% CI, 0.22-0.79; P=.007). Operation was associated with reduced mortality in patients with paravalvular complications (ARR, -40.5%), severe heart failure (ARR, -32%), and native valve endocarditis (ARR, -17.8%). CONCLUSION: This study supports the benefit of surgical treatment in patients with left-sided IE carried out during the initial phase of hospitalization, especially in patients with moderate or severe heart failure and paravalvular extension of infection.
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